[27] Constipation Flashcards
What can constipation in children be defined as?
The infrequent passage of dry, hardened faeces, often accompanied by straining or pain and bleeding associated with hard stools
What is the problem with defining ‘normal’ frequency of defecation?
Highly variable, and varies with age
What is the average frequency of defecation in the 1st week of life?
4 stools per day
What happens to the frequency of defecation by 1 year?
It falls to an average of 2/day
How long may it take for breastfed infants to pass stool?
Several days
What are the causes of constipation in children?
- Underlying conditions
- Lack of high-fibre foods
- Difficulties with potty training
- Anxiety
- Anal fissure
Are primary causes for constipation common?
No, rare
What underlying conditions should be considered in a child with constipation?
- Hirschsprung’s disease
- Lower spinal cord problems
- Anorectal abnormalities
- Hypothyroidism
- Coeliac disease
- Hypercalcaemia
Give an example of when anxiety may lead to constipation
Anxiety about opening bowels in school or in unfamiliar toilets
What are the risk factors for constipation?
- Sedentary lifestyle
- Certain medications
- Medical conditions affecting anus or rectum
- Family history of constipation
What are the symptoms of constipation in children?
- Infrequent defecation
- Large stool that is difficult to pass
- ‘Rabbit dropping’ stools
- Abdominal pain, which waxes and wanes with passage of stool
- Overflow soiling
What is found on examination in constipation?
Normally reveals a well child, with normal growth, soft abdomen, and normal examination of back and perineal area
Should you do a DRE in children with constipation?
No, refer to specialist if required
What are the amber flag signs in constipation?
- Faltering growth
- Signs of possible maltreatment
- Perianal streptococcal infection
What should be done when faltering growth is present with constipation?
Test for coeliac disease and hypothyroidism
Give two examples of signs of maltreatment in constipation
- Perianal bruising
- Multiple fissures
What should be done when there is perianal streptococci infection in constipation
Treat for constipation and infection
What should be done if there are any red flag symptoms in constipation?
Do not treat constipation, and refer urgently to relevant HCP
What are the red flag symptoms of constipation?
- Failure to pass meconium in first 24 hours of life
- Gross abdominal distention
- Abnormal lower limb neurology or deformity
- Sacral dimple over natal cleft/spine
- Abnormal appearance/patency of anus
- Perianal fistulae, abscess, or fissures
What is the concern when there is failure to pass meconium in the first 24 hours of life?
Hirschsprungs
What is the concern when there is gross abdominal distention with constipation?
Hirschsprungs, or another GI dysmotility
Give two examples of abnormal lower limb neurology or deformity that would be a red flag sign in constipation
- Talipes
- Secondary urinary incontinence